A Matter of Civil Rights
By Andrew Malekoff
Did you know that every day
more than 290 Americans die from suicide or a drug overdose? With proper
treatment, many of these tragedies could be prevented—but despite a law that
guarantees coverage, people face enormous roadblocks when they seek care.
In 2008 President George W.
Bush signed the landmark Mental Health Parity and Addiction Equity Act (Parity
Act). The Parity Act mandates equal insurance coverage for mental health and
substance use disorders (MH/SUD) as compared to other medical/surgical benefits covered by the plan.
According to its new website parityat10.com, “Parity at 10 seeks to ensure that insurance carriers and state Medicaid programs comply with the law so that consumers can access the evidence-based health care they need and are entitled by law to receive.”
What does equal insurance
coverage mean? It means ending insurer discrimination against access to timely
and affordable care including high out-of-pocket costs and shorter lengths of
care for MH/SUD. Parity—which is another word for equity—in this case means
that MH/SUD coverage must be provided on par with coverage of medical and
surgical care.
Notably this legislation was
the result of a bipartisan effort by Senators Paul Wellstone, a liberal
Democrat, and Pete Domenici, a conservative Republican. What the senators had
in common were personal family experiences that motivated their tireless
efforts to pass this law.
Parity saves lives. Parity
law is a civil rights law that has not been vigorously enforced by the States,
which have the primary responsibility for enforcement of private insurance and
Medicaid.
One of the most pernicious
violations and barriers to care is inadequate networks of MH/SUD providers.
North Shore Child & Family Guidance Center documented this in its 2018
Project Access Study which surveyed 650 Long Island consumers of MH/SUD care.
Nearly 50% of respondents said that it was easier for them to access
medical/surgical care than MH/SUD Care.
Nationally, patients
responding to a National Alliance on Mental Illness (NAMI) survey reported
being denied twice as often for mental health care as for medical surgical care
under the Affordable Care Act.
The actuarial firm Milliman
reviewed claims data in New York and found that patients had to go
out-of-network for MH/SUD care far more often than for medical/surgical care—a
very expensive proposition that flies in the face of the Parity Act.
At North Shore Child &
Family Guidance Center, we are a proud partner of the Parity at 10 Compliance
Campaign. On August 10 I attended an inaugural Parity at 10 meeting in Albany
with my fellow advocates and top officials in the Cuomo administration.
Some of the details in this
column were included in the policy brief provided to Governor Cuomo. The
consensus among the advocates was that insurers do everything in their power to
skirt parity.
Another staunch supporter of
the original legislation was Patrick J. Kennedy, a former member of the U.S.
House of Representatives. Kennedy struggled with mental illness and addiction
for most of his life.
In his book A Common Struggle, Kennedy said the
battle ahead is for the law to be enforced in the face of health insurers who
stand to profit by denying the full range of coverage for people living with
mental illness and addictions. Kennedy rightly frames the inequities that
people with mental illness and addictions face as a matter of civil rights.
Discriminatory insurance coverage
for those with mental health and substance use disorders must end. When
insurers do not comply with the law and enforcement is inadequate, millions of
Americans are at risk.
Andrew Malekoff is the Executive Director of North
Shore Child & Family Guidance Center, which provides comprehensive mental
health services for children from birth through 24 and their families. To find
out more, visit www.northshorechildguidance.org.
This article appeared in TheIslandNow.com on August
16, 2018
